一期后路松解复位治疗难复性寰枢椎脱位型颅底凹陷症  

One-staged release and reduction by posterior approach to treated basilar invagination with irreducible atlantoaxial dislocation

作　　者：徐韬[1] 甫拉提·买买提[1] 买尔旦·买买提[1] 郭海龙[1] 盛军[1] 邓强[1] 盛伟斌[1] 

机构地区：[1]新疆医科大学第一附属医院脊柱外科,乌鲁木齐830054

出　　处：《中华骨科杂志》2017年第4期201-209,共9页Chinese Journal of Orthopaedics

摘　　要：目的评价一期后路松解复位内固定治疗颅底凹陷症（basilar invagination，BI）合并难复性寰枢椎脱位（irreducible atlantoaxial dislocation，IAAD）的安全性和有效性，探讨一期后路松解复位内固定手术的适应证和关键技术。方法自2000年7月至2015年6月共收治颅底凹陷症合并难复性寰枢椎脱位患者17例，男8例，女9例；年龄12-56岁，平均（35.2±13.8）岁。记录其临床症状和体征，摄正、侧及动力位X线片并行MR和CT检查。其中寰枕融合14例，C2，3融合7例，小脑扁桃体下疝6例，脊髓空洞积水6例，高颈髓内软化灶8例。临床表现为头、颈部疼痛15例，颈部活动受限13例，短颈或后发际低9例，头颈部倾斜12例，肢体麻木或感觉障碍14例，四肢无力、行走困难13例，四肢腱反射活跃16例，共济失调13例。所有患者均行一期后路经寰枕或寰枢关节松解、复位，枕颈融合内固定术。术后通过X线片、MRI和（或）CT观察减压和固定情况至植骨融合，手术前后及末次随访时神经功能评价采用日本骨科协会（Japanese Orthopaedic Association Scores，JOA）评分和Ranawat分级。应用配对t检验对手术前后的影像学参数进行统计学分析。结果手术时间90-210 min，平均145 min；出血量150-350 ml，平均175 ml。所有患者均获随访，随访时间9-94个月，平均（44.47±33.44）个月。术前JOA评分4-10分，平均8.06分；术后JOA评分为13-16分，平均15.20分，改善率为77.2%，优良率为100%。术前Ranawat分级Ⅱ级1例、ⅢA12例、ⅢB 4例；术后Ⅰ级13例、Ⅱ级4例。术前Chamberlain线（CL）、Wackenheim线（WL）、McGae线（ML）、寰齿间距（atlantodental interval，ADI）和颈髓角（cervico-medullary angle，CMA）分别为（12.52±5.17）mm、（6.59±3.04）mm、（6.96±4.32）mm、（9.88±1.93）mm和115.35°±12.40°；术后改善为（2.0±3.67）mm、（-3.06±1.85）mm、（-1.76±2.88）mm、（Objective To evaluate the safety and effectiveness of one stage surgery of release and bone reduction by posterior approach to treat basilar invagination （BI） with irreducible atlantoaxial dislocation （IAAD）, and to explore the indications and crucial techniques of posterior approach. Methods All of 17 Consecutive patients （8 males and 9 females） with BI and IAAD who underwent release and reduction by posterior approach from July 2000 to June 2015 were enrolled in the present study, the mean age was 35.2±13.8 years with a range of 12-56 years. The clinical symptoms and signs was recorded, and preoperative imaging examination, including anteroposterior, lateral, dynamic films, MRI and CT of cervical spine, were performed to identify the series. There were 14 cases with atlanto-occipital fusion, 7 cases with C2,3 fusion, 6 cases with Chiari malformation, 6 cases with Syringomyelia, and 8 cases with myelomalacia. The clinic symptoms include occiput/neck pain in 15 cases, cervical movement limitation in 13 cases, short neck in 9 cases, torticollis in 12 cases, Paresthesia in 14 cases, weakness in 13 cases, tendon reflexes hyperfunction in 16 cases and ataxia in 13 cases. The postoperative X-rays, MRI or CT were used to observed the results of decompression, fixation and fusion. Neurological function was assessed by JOA scale and Ranawat＇s score before, after surgery and at final follow-up. Pre- and post-operative Chamberlain （CL）, Wackenheim （WL）, McGae （ML）, atlantodental interval （ADI） and cervico-medullary angle （CMA） were analyzed by student t-test. Results The average operation time was 145 mins （90-210 mins） and blood loss was 175 ml （150-350 ml）. The average follow-up was 44.47 months （9-94 months）. JOA score was increased from 8.06 preoperatively to 15.20 postoperatively, the improvement rate was 77.2%. Preoperatire Ranawat＇s score was Ⅱ in 1 case, ⅢA in 12 cases, ⅢB in 4 cases. Postoperative score was Ⅰ in 13 cases, Ⅱ in 4 cases. The preoperative CL,

关 键 词：颅底 寰枕关节 寰枢关节 脱位 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]